EMS Shift Lengths And Overnights At Private Ambulance Companies

[helicopper 1,050]

Brian,

I think if you review most major ambulance companies financial statements, you will see that, compared to 911 calls, most revenue is derived from inter-agency transports, in New York and nationwide. Although you might think otherwise from reviewing financials from your organizations, I have reviewed statistics from a much larger database, which includes Rural/Metro, AMR, etc. etc. You might see it similarly if you look around and see that some ambulance companies start off as solely inter-agency transports because there is less regulation (more liability but less regulation) and less overhead needed. Although Medicare/Medicaid rates still are the same as they were when the legislation was first enacted, EMS, much like hospitals in America, still derive a majority of income from Medicare/Medicaid. I can direct you to resources such as the American Ambulance Association and the American Hospital Association websites for statistics. Once these companies get their feet firmly planted on sound financial ground, they then expand to 911 transports to attract a larger employment base.

One member's comment regarding NY being Right to Work State is absolutely correct. For the most part, NY is a Right to Work State. The EMS industry needs to advocate to become more regulated insofar as hour regulation, much like the health care industry, if we are indeed concerned that patient care is suffering from an overworked EMS worker.

As a third year law student, and EMS worker, I look forward to representing the industry in my spare time. I agree with you insofar as the EMS industry needs advocacy. It is ridiculous when it does more call volume than Fire, yet gets paid half of the amount.

Insofar as my original reply, I regret the reply because the comment was targeted toward low wage rates. So, I apologize if I distorted your comment.

JDR

JDR, you're absolutely right that the collection success for transports is higher than 911 calls. However the actual rate being compensated is far less than the actual cost (especially with skyrocketing fuel costs) of the service provided so most agencies are operating at or near a loss.

This forces agencies to pay as little as possible and cut other corners to "do things on the cheap" just to stay solvent. I remember colleagues rushing to the bank on payday to make sure the bank cashed their check because they weren't sure the company could make its payroll week to week. That's a huge problem!

Without a more level playing field: better representation and advocacy, higher wages, higher Medicare/Medicaid payments for service, more job security, etc. it's going to be hard to make EMS the true profession it should be.

[ny10570 745]

Don't let these companies fool you guys. There are a few that are barely keeping their heads above water, others that are doing quite well, and others that are rapidly growing. 911 is a money loser, no doubt about it. Thats why you don't see commercial agencies that just do 911. Transports make money. If they didn't then how do you explain, how Transcare, Empress/Emergacare, WEMS (I know WEMS is a not for profit subsidized by Stellaris but even they are not free to just lose money) survive in Westchester. They don't even have all the transports in the county as agencies like Empire, Lifeline, and Senior Care handle some.

[firemoose827 324]

I appreciate all of your input and knowledge. But, let me explain one thing that most of you either are forgetting about or just dont know about with transports and the insurance reimbursement.

We fill out a form in our company called a "CMN", Certificate for Medical Necessity. You all have probably heard of these and use them regularly. Now, these forms are used to prove the need for medical transport by ambulance and whether or not the Level of care provided for that PT is appropriate. The doctors are supposed to fill them out and state in their writing why the PT is being transported, IE "Pt severe Hemiplegia and neuro deficit, our facility unable to care for PT appropriately, transfer to Regional Stroke Center for further treatment." If these forms are not filled out correctly, and the need does not exist, the insurance carrier will deny payment. I have seen some filled out as " Pt doesnt feel good, we are full and cant find bed." SERIOUSLY!! I have! And when the doctor was approached they ran from me like a famous actor running from the papparazi!

To further the complications, they look at the PCR and determine if the treatment rendered was appropriate for the Chief Complaint and if not they deny payment. BASICALLY, the insurance companies will find an excuse to deny payment in just about everything.

To all of you about to rip into me about my PCR Documentation...STOP... I make sure my RX of the patient and documentation of the treatment are complete and appropriate for the pt. A lot of my fellow employees do not, and they repeatedly get called in for their paperwork. It happens everywhere. There are just some people who cant write a PCR and cant learn how to either.

A majority of our claims come back denied because the company feels that the ambulance ride was not justified. You can read all the reports you want...they will all tell you that the main income for paid ambulances are transports but they go on what the agency "Bills Out" for, not on what the company actually gets "Reimbursed" for.

Everyone, Have a great Thanksgiving!! Dont eat too much Turkey!

[smwells 7]

I have seen enough CMN forms filled out, it looked like they were done in my college creative writing class..

Most of them are written to ensure payment of services, regardless of the Pt having a hang nail or in full arrest. If you are sent on the job, the company expects to get paid. They dont lie on the form, but they certainly beef up the issue.

Edited November 26, 2007 by smwells

[helicopper 1,050]

I have seen enough CMN forms filled out, it looked like they were done in my college creative writing class..

Most of them are written to ensure payment of services, regardless of the Pt having a hang nail or in full arrest. If you are sent on the job, the company expects to get paid. They dont lie on the form, but they certainly beef up the issue.

Unless they change the rules and allow ambulance companies/EMS agencies to refuse service in instances where there is 'no medical necessity', I think the insurance providers should be compelled (by law if necessary) to pay for the service rendered - even if it was only transportation (reimbursed at an appropriate rate for simply transportation). To resort to completing a form essentially pleading for payment reduces us to high end panhandlers. The insurance industry will not go broke paying for transportation and medical intervention when necessary.

It's a shame that this is allowed to persist - it's the same as it was when I first started in the transport game many moons ago.

[Goose 188]

As a few have said, its about the money. A CMN offers both the physician ordering the transport and the agency looking to get paid a paper trail. The CMNs i work with are pretty streamlined, essentially the MD has to check a box as to why an ambulance is necessary and then give a one or two sentence explanation. The real problem, as i see and understand it, is with the government subsidized programs and their decreasing payouts (which the privates usually adjust to).

[ckroll 101]

OK, someone educate me. Who fills out the CMN? As a 911 medic, I've not been exposed to the transport experience, and never bothered with them. All of a sudden we're being asked to fill out CMN's on 911 assignments. The forms don't seem structured to 911 calls. What is their purpose exactly?

[50-65 205]

I know that when I worked doing transports, we were supposed to fill out the CMN and have it signed. The form we used was very simple with two boxes to check. One for if the pt needed an ambulance, one for ambulette. On the back of the form, we had to put the reason why the pt needed a stretcher. Sometimes, depending on the transport, I would not fill it out. There was no need for it.

One pt that we regularly transported was for dialysis. Not to say that this guy didn't have problems. He was brain damaged and in a wheelchair. An electric, motorized chair that he could somewhat control. He didn't need an ambulance. His mother, with whom he lived, didn't want to be inconvenienced (IMO) and insurance wouldn't pay for a 'lette. So they wanted us to fill out the form that he needed a 'lance. I wouldn't do it. Once we had to wait for him to get home from getting his hair cut before we could transport.

Anyway, that is way off topic from the OP. When I worked at the company that was originally the base for this topic, 12's were normal schedule, 24's were common, and 36's were not unusual. My top week there was 96 hrs.

[Guest]

what you paid guys need is a friggin union...and maybe a CDL like someone mentioned.

if you had a union you'd have better pay, better benefits and get treated better and not to mention you would have someone fighting for you in times where a change is needed.

im a vollie and i vollied about 36 consecutive hours ONCE (big snow storm kept me at the vac), and i was loosing my mind at the 20 hour mark! and not to mention i was in a nice 2 story vac with tv's, movie channels and a pool table...and i did sleep and slept well.

i really don't know how you guys do it, but i give you a lot of credit. but, working too many hours is like drinking to much...you should know you limit. but with the cost of living so friggin high, its obvious why people work more than they should.

other than my union input, i have no business in this thread...i really hope the best for you guys, but i can't see any substancial improvements without union representation...how do you like the name Local 911!!?

Stay Safe out there!

Edited December 2, 2007 by vacguy